While intravenous TXA has proven efficacy in reducing perioperative blood loss, despite its routine use during major paediatric spine surgery, blood loss and transfusion requirements remain significant (14-23). Thus, methods to further reduce perioperative blood loss in the children are of clinical significance. As highlighted above, topical TXA has clearly demonstrated excellent local anti-fibrinolytic action. Furthermore, when applied within a surgical incision, there is a negligible increase in serum TXA concentration (33-35).